FormerMember

Someone (VA?) is blowing smoke up your rear end. I can get anyone SC for anything at any time regardless of how many times or when they got denied or in which order.  Here's a pertinent example. My Vet goes to Vietnam and loads caskets on departing C-141s at TSN for 8 months. He helps unload wounded from Dustoffs. Finally, it warps him and he begins snorting smack. The AF pulls him aside and gives him a one-time shot at rehab and a clean sheet. They evac him to Wilford Hall MC at Lackland AFB in San Antonio. He is cleaned up but his psyche is irreparably damaged. They 86 him and give him a DD 257 as an incorrigible drug addict with personality disorders. I wrote this in 2015- a full year before I was accredited by VA. https://asknod.org/2015/08/20/the-good-humor-man-at-tan-son-nhut-ab/
He filed for bent brain as he left in '70. VA denied and said his Heroin and ETOH were the cause of his mental disorders. He lost 5 more times to the present (2015). I filed anew last fall and tuned up the claim with a good, rewritten stressor. No buddy letters. No evidence of PTSD or GAD (back in those days we called it Generalized Anxiety Disorder) in service.  VA examined him and denied yet again this spring. Denial was for "no dx of PTSD".  VA insisted he had a MDD secondary to drug addiction for 48 years. Suddenly, now, there's no mention of all those denials based on drugs being the reason he's bent. I promptly went to my nexus doctors and got a beautiful dx of PTSD due to all those human popsicles in caskets he was loading. I got the shrink to say the drugs were an attempt to self-medicate and good medical treatises on the fact that drug use doesn't cause bent brain syndrome. VA just scheduled a new c&p to rate him on Friday last. Never ever, ever depend on VES/QTC doctors to write a favorable nexus. VA denied for every reason under the sun for 48 years. I won on attempt #6 because it's a simple recipe. If you refuse to follow it, you lose. In the instant case mentioned above, you (dlove74us) are being given bogus info and told to believe it.
One thing I have learned in my 30 years of doing this is the need for essential, valid knowledge. There is a lot of incorrect info out there being disseminated to Vets-often by VSOs. Once you understand the "game", you cannot lose. This presumes you have a legitimate claim (but I treat that as a given). VA denies by depriving you of a nexus-not because you are not entitled- but because they are an Insurance Co. That's what they do. They deny and frequently in case nobody noticed. You merely have to get the nexus letter to win-even if you don't get it for 48 years. 
One trick most do not realize is the old "benefit of the doubt" rule we laugh about. You file. VA denies. You get your IMO and file it with your NOD. VA is forbidden to develop negative evidence against you so the claim is now in equipoise. Equipoise = tie goes to the runner-ergo you win. You may have to go to the BVA on some contentious point of law like a jetgun claim for Hep C. In that case, you hand your IMO to a VLJ rather than a dumb-s__t rater. Bingo, you win. Let VA deny. They have to have a succinct "Finding of Fact" to deny with. Let them develop this finding so you can rebut it with a nexus. Turn their game against them. Once they commit with their negative nexus, you have the opportunity to rebut with your IMO and will win.  Sadly, I see many develop their claims and think VA is going to see the light and agree with them. Not. The M 21 was not developed to grant claims. It sounds good but the manual is designed to provide the excuse needed to deny with. I buy my nexus letters for a flat $2,000 apiece. They are always bulletproof.
I've had 4 losses in about 1000 attempts since 2008. Reasons? 1) Liar (was never in Vietnam); 2) Liar (admitted to drug addiction in 1993 and then testified in 2014 he was clean as the driven snow); 3) Lied about OTH discharge; and 4) Liar (lots of UCMJ violations for more things than I can list here and most were not LOD). You win because a) you're right  and b) you told the truth. If the STRs and the claims file bear out your contentions, you will always succeed. If you failed, you forgot to supply one of the needed three ingredients. If I can get a Vet SC for glioblastoma for Camp LeJeune water and it isn't on the list, then you folks can do it too.  https://www.va.gov/vetapp18/files3/1815897.txt
I'm not a miracle worker nor do I profess to be one. I use VA's game against them. I suggest you do the same.

A lot of ideas, a lot of conjecture and a lot of suggestions. Let's look at VA's more recent views on SMC.
First, for the higher rates (SMC L and above), the M 21 has tried desperately to conjure up a requirement for a 100% or TDIU rating as the entry ticket to even be considered for the SMC. So, in this case, The Veteran (8th&IMarine) is applying for a&a. A&A doesn't require a 100%/TDIU rating to enter the lottery. Look at §3.151(c)(3):
(c) Aid and attendance; criteria. The veteran, spouse, surviving spouse or parent will be considered in need of regular aid and attendance if he or she:
(1) Is blind or so nearly blind as to have corrected visual acuity of 5/200 or less, in both eyes, or concentric contraction of the visual field to 5 degrees or less; or
(2) Is a patient in a nursing home because of [SC] mental or physical incapacity; or
(3) Establishes a factual need for aid and attendance under the criteria set forth in § 3.352(a).
(Authority: 38 U.S.C. 1502(b))   A Veteran can always go for the extraschedular path to get there, too. But let's look at what we have here. 8&IMarine seeks a SMC L for a&a. He has to prove he cannot accomplish one or more of the activities of everyday living listed in §3.352(a). VA, by operation of law, is going to investigate what particular disability(ies) are responsible for the A&A. S/he is asking VA to determine if s/he is eligible. Akles v. Derwinski and its progeny demand they investigate any and all of his/her SC stuff to determine if they can grant more than just the A&A (or deny). This is open and shut "inferring" a claim for increases that should be rated. Maybe not. A good 2680 ( the eleven page, inward-facing VA DBQ) would be essential here if completed by your private physician. In any case, as BroncoVet points out, it's a §3.103(a) argument-by law they have to maximize your rating. They don't.   What I encounter nowadays is an "everything but the kitchen sink" mentality. VA can (and will) say you need a&a for all those disabilities. So, what happens if you get worse on one of the musculoskeletal issues later-like up to 100% worse? You file for a&a for that one separately and VA says ''sorry charlie-you're using that for the #1 a&a. That would be pyramiding''. I spend an inordinate amount of time trying to de-link these things and get a separate 100% disability rated under SMC L. I always end up at the BVA, too.   Say you went the 100% + 60% and got your SMC S. If you file for a&a and they grant, $100 says they throw all your SMC S stuff into the a&a and deny you any 1/2 step bumps under §3.350(f)(3) or a full step bump under (f)(4) for a 100% rating separate and distinct from the a&a. By law, they can't call something separate and distinct  and independently ratable in 2017 and then come back in 2021 and say it's all one disease/injury process. VA does this to head you off at the pass in the future. They sure don't want you scheming to get R1 if they can cram it all into one a&a rating now. And, it's illegal too.   My advice, for what it might be worth, is to let this ride and see what they develop. You can always NOD and say you never filed for the claims-ergo they are void ab initio. If you file for a&a, try to be specific in your request ("My arthritis makes it impossible to button my shirts or tie my shoelaces." or" My PTSD causes me to forget to take my medications.") If you do not, you'll get the kitchen sink treatment. When, and if, your PTSD does get rated at 100%, you'll want to be filing for a&a for that alone later. You don't want it inextricably intertwined as one of the partial ingredients for the kitchen sink grant of a&a in the present claim. Since the claim is open currently, you could submit a 4138 or the newer 21-10210 version and testify your a&a need is based strictly on your SC  ______________. Get your PCP to write up the 2680 focusing strictly on the disability that provokes the need for a&a.   A lot of Vets do not get this. Filing two A&As is not pyramiding. It's two separate paths to get there (r1) and both are legal. So what if your need for a&a because of your PTSD appears to duplicate your need for a&a due to your Parkinson's? This is the anomaly of SMC. It permits pyramiding primarily because its a quality of life issue, not a ratings percentage of disability. If you have two totally disabling illnesses/injuries, each separately is a qualifier for a&a. Always think big. Do not confine your SMC thinking to the four corners of §3.350(b)(1-4).    Happy Veterans Day. 

Let's cut to the chase. There is no CUE here. A subcontractor/clinician from QTC/VES/LHI has been trained to ask you when you come in for a c&p : "How are you today?" Most folks will answer neutrally or say something to the effect that they are "Fine, and you?" This is a pleasantry normal people exchange with one another. VA, however, will always weaponize it to extrapolate it to mean you are stating you are fine and denying anything is wrong with you. I've been watching this phenomenon ever since it happened to me in 1989. VA has a finite bag of tricks to deny with. They can legally say that you went to a psych c&p and no diagnosis was rendered of a mental disorder or your claimed disability of ________________ (fill in the blank). Right there at that point if you had obtained a private nexus letter (IMO) from a shrink saying you had bent brain syndrome, you would have prevailed. Ditto right foot pain.
But, as you say, you did not know how the dog and pony show worked back then. Most Vets didn't and still don't. You didn't appeal and that was fatal to revisiting this denial now in 2022. As Berta pointed out, you can never argue how the evidence was decided in CUE. As for §3.156(c), do you have relevant medical records which show a real, bonafide dx of MDD while in service which has never been made a matter of record? If not, that theory goes down the drain. 
Anxiety/GAD/ PTSD/MST/Bipolar etc. are a group of major depressive disorders (MDD) adjudicated under §4.130. Pyramiding prevents an award for each one. There are 31 different forms of MDD. As with all claims, I almost always find that someone "diagnosed" a Vet w/ MDD in-say 2005. But the diagnosis was done by someone with a MHS (mental health specialist) "degree" after their name. No dice. It has to be a psychologist with a real degree in psychotherapy-not a six month degree out of a Crackerjacks box. They'll have Psy.D after their name. 
I think everyone reading this knows you got screwed. The repair order is extremely limited. You say you got the 70% in 2015. Unless you're still litigating that as an active justiciable appeal, it, too, is a final decision which could only be overturned by a clear and  unmistakable error of law. I've had claimants say at a c&p that they think they got Hep. C from a jetgun. Bad idea. You are not a doctor so that is off limits. But what you will often see is the clinician state that you admitted to a history of illicit drug use and that explains it. Of course you didn't say that but how do you negate that statement? It's too late. Sure, VA is not allowed to do it but they do. That's why Theresa invented this gig. We teach you how not to step on your necktie. In your case, I think that ship has already sailed but without a review of the claims file, it's impossible to say with any certainty.
One trick I've learned to reopen these as a §3.156(c) claim is to go back to the NPRC and ask for any "inpatient records" if you were ever admitted to a military hospital. These records are kept separate in another building at NPRC and are almost never included in any SF 180 request. I went back three times and got a new tranche of records each time. If any of these are pertinent to your 2005 claims, then you can get a can opener into an earlier effective date. It's perfectly legal to get a retrospective IMO and have a dr. opine as to what  your mental state was back then when you're doing a §3.156(c) claim.  
Best of luck.
 

Let's cut to the chase. There is no CUE here. A subcontractor/clinician from QTC/VES/LHI has been trained to ask you when you come in for a c&p : "How are you today?" Most folks will answer neutrally or say something to the effect that they are "Fine, and you?" This is a pleasantry normal people exchange with one another. VA, however, will always weaponize it to extrapolate it to mean you are stating you are fine and denying anything is wrong with you. I've been watching this phenomenon ever since it happened to me in 1989. VA has a finite bag of tricks to deny with. They can legally say that you went to a psych c&p and no diagnosis was rendered of a mental disorder or your claimed disability of ________________ (fill in the blank). Right there at that point if you had obtained a private nexus letter (IMO) from a shrink saying you had bent brain syndrome, you would have prevailed. Ditto right foot pain.
But, as you say, you did not know how the dog and pony show worked back then. Most Vets didn't and still don't. You didn't appeal and that was fatal to revisiting this denial now in 2022. As Berta pointed out, you can never argue how the evidence was decided in CUE. As for §3.156(c), do you have relevant medical records which show a real, bonafide dx of MDD while in service which has never been made a matter of record? If not, that theory goes down the drain. 
Anxiety/GAD/ PTSD/MST/Bipolar etc. are a group of major depressive disorders (MDD) adjudicated under §4.130. Pyramiding prevents an award for each one. There are 31 different forms of MDD. As with all claims, I almost always find that someone "diagnosed" a Vet w/ MDD in-say 2005. But the diagnosis was done by someone with a MHS (mental health specialist) "degree" after their name. No dice. It has to be a psychologist with a real degree in psychotherapy-not a six month degree out of a Crackerjacks box. They'll have Psy.D after their name. 
I think everyone reading this knows you got screwed. The repair order is extremely limited. You say you got the 70% in 2015. Unless you're still litigating that as an active justiciable appeal, it, too, is a final decision which could only be overturned by a clear and  unmistakable error of law. I've had claimants say at a c&p that they think they got Hep. C from a jetgun. Bad idea. You are not a doctor so that is off limits. But what you will often see is the clinician state that you admitted to a history of illicit drug use and that explains it. Of course you didn't say that but how do you negate that statement? It's too late. Sure, VA is not allowed to do it but they do. That's why Theresa invented this gig. We teach you how not to step on your necktie. In your case, I think that ship has already sailed but without a review of the claims file, it's impossible to say with any certainty.
One trick I've learned to reopen these as a §3.156(c) claim is to go back to the NPRC and ask for any "inpatient records" if you were ever admitted to a military hospital. These records are kept separate in another building at NPRC and are almost never included in any SF 180 request. I went back three times and got a new tranche of records each time. If any of these are pertinent to your 2005 claims, then you can get a can opener into an earlier effective date. It's perfectly legal to get a retrospective IMO and have a dr. opine as to what  your mental state was back then when you're doing a §3.156(c) claim.  
Best of luck.
 

As I am accredited, I am not permitted to conduct business on an open forum for fear of divulging PII. If you would, please send me an email with the scanned .pdf you mention attached to gagraham51@gmail.com. I would be happy to take a gander and see if anything jumps out and bites me on the eye. Please explain in the email the case or controversy contention, the cite/reg/statute you rely on and which VA violated and the outcome-determinative error if it isn't adequately explained. 
r
a

A review of your listed disabilities would be broken down by VA for SMC S purposes thusly:
Your cardio problems fall into The Cardiovascular System (§§ 4.100 - 4.104). Aortic aneurysm is rated as 100% under DC 7110. Hypertension, if due to a heart issue is rated under DC 7007. If due to a vascular disease process such as Diabetes Mellitus type II, under DC 7101. Regardless, both are considered part of the cardiovascular ratings. Your ischemic stroke with right homonymous hemianopia is, again a product of the cardiovascular system. I suspect it is rated as an intraocular hemorrhage under §4.79 DC 6007. On this one, VA may say it's a  part of the stroke which would again still be in the cardiovascular arena but since it is rated at 30%, I expect it could be an eye rating under §4.79 DC 6007 for intraocular hemorrhage or for loss of visual field. 
In addition, you have lower extremity scars bilaterally, presumably due to your peripheral vascular disease. Scars are rated under skin (a separate and distinct issue from a cardiovascular disease) involving a different bodily system. Skin is rated under §4.118. Lastly, you have tinnitus which is rated under §4.87 DC 6260.
In sum, you have 30% for the eye, 10% for scars plus 10% for De Luca Pain bilaterally and 10% for the tinnitus. Using §4.25, you can see 30% + 20% + 10% = 50%
Without a doubt, due to the cardio issues all being part of the same bodily system, you will not have enough to reach 60% or more based on separate and distinct ratings from the cardio. Which is not to say you couldn't file for other disabilities secondary to the cardio such as a MDD which is separate and distinct (mental under §4.130).
Personally, I don't see anything that could ever rise to the level of a CUE here. I've done hundreds of SMC CUEs and every one of them was a failure to infer the highest SMC entitlement under Akles v. Derwinski precedence without having to be prodded with a pitchfork by the Vet to grant it. VA generally will declare CUE on themselves when I catch them at it and then write a new rating decision granting the proper SMC. In your case, you simply don't have enough ratings that are separate and distinct that equal 60% or more to qualify. 
Best of luck, sir.  

Mr. CUE---
Here's the meat of Akles v Derwinski:
Specifically, the Veteran asserts that the Board’s June 2001 decision failed to infer a claim for SMC from the evidence then of record.  The Veteran has emphasized the U.S. Court of Appeals for Veterans Claims (CAVC’s) earlier 1991 holding that a claim for increased disability compensation may include the “inferred issue” of entitlement to SMC, even where the veteran has not expressly placed entitlement to SMC at issue.  Akles v. Derwinski, 1 Vet. App. 118, 121 (1991).  The Veteran maintains the Board failed to apply the holding of Akles to the evidence then of record.  The Veteran notes that the June 2001 Board decision found that the Veteran’s service-connected knees were incapable of bearing weight, such that he was confined to a wheelchair, and asserts that such factual finding “undebatably” supports the Veteran’s was incapable of performing acts of balance and propulsion due to his service-connected knees.  In essence, the Veteran contends that the Board had already made all of the requisite factual findings necessary to establish entitlement to SMC based on the loss of use of the lower extremities, but ultimately failed to explicitly adjudicate such issue to the detriment of the Veteran.  The Veteran asserts that had this CUE not occurred, the outcome of the Veteran’s case would have manifestly been different - in addition to being granted the increased ratings for his bilateral knee disabilities, he would have also been entitled to SMC based on loss of use of his legs preventing natural knee action under 38 U.S.C. § 1114(m).
Both the CAVC and the Federal Circuit Court have held the RO's failure to address an implied claim is an action that can be challenged through a motion for CUE.  Evans v. McDonald, 27 Vet. App. 180, 185 n.3 (2014) (en banc); Deshotel v. Nicholson, 457 F.3d 1258 (Fed. Cir. 2006).  When presented with such a request, VA must first give a full and sympathetic reading to the claimant's prior submissions to determine whether such a claim was reasonably raised.  Roberson v. Principi, 251 F.3d 1378 (Fed. Cir. 2001); Szemraj v. Principi, 357 F.3d 1370 (Fed. Cir. 2004).  If it is determined that a claim was reasonably raised, VA must then determine whether such a claim is pending or whether it was adjudicated as part of a final decision.  If such a reasonably raised claim remains pending, then there is no decision on that claim to revise on the basis of CUE.  In that situation, the pending claim must be adjudicated by VA.  However, if VA determines that the claim was adjudicated, and is no longer pending, then the claimant may collaterally attack the resulting decision on the basis of CUE.  Richardson, 20 Vet. App. at 71-72.  Stated another way, the Secretary’s failure to adjudicate a reasonably raised claim can be the basis of the CUE motion as to a final decision of the Secretary where the issue was relevant to a decision actually made.  Ingram v. Nicholson, 21 Vet. App. 232, 254-55 (2007).
VAOPGCPREC 4-2004 (May 28, 2004)
SMC may be granted to Veterans who are so disabled that they require regular aid and attendance or are housebound. Prejean v. West, 13 Vet.App. 444, 447 (2000)

That's where the VA and I digress. VA likes to throw anything and everything associated with a disease into the same basket. The actual language, as parsed in numerous CAVC cases, is the unique language used in §3.350(f)(3) and (4)-
-  must be separate and distinct and involve different anatomical segments or bodily systems.
Based on this, and all the cases I've won citing to this interpretation of the language in the regulation, psoriasis is rated under §4.118. Arthritis is rated under Musculoskeletal (§4.71a) between DC 5002-5010. As such, they are two separate and distinct disease processes/ bodily systems. This is what  I always argue at bar.
With that said, look at DM II or Parkinson's. VA tends to lump everything together. DM II gets PN and DR (diabetic retinopathy) thrown in on top. Sometimes even renal deficits. I've won L using that argument. Parkinson's gets the same full meal deal treatment with all the extremity deficits combined with facial muscle sag, trouble swallowing, etc. I've won using this argument too.  
What VA does with the SMC S will in large part control what happens some time in the future with an a&a rating. VA will definitely argue the psoriatic arthritis is secondary to the psoriasis under §3.310- which it is. But, for rating purposes under §4.25(b), they are separate and distinct and involve different bodily systems. 
Trust me when I say someone will come along and disagree with me on this subject but my experience is based on actual hands-on litigation for clients-not speculation and conjecture about what VA might or might not do. SMC is very difficult to fathom. My advice is to stress that the two diseases are not one. 
Best of luck, sir.

That's where the VA and I digress. VA likes to throw anything and everything associated with a disease into the same basket. The actual language, as parsed in numerous CAVC cases, is the unique language used in §3.350(f)(3) and (4)-
-  must be separate and distinct and involve different anatomical segments or bodily systems.
Based on this, and all the cases I've won citing to this interpretation of the language in the regulation, psoriasis is rated under §4.118. Arthritis is rated under Musculoskeletal (§4.71a) between DC 5002-5010. As such, they are two separate and distinct disease processes/ bodily systems. This is what  I always argue at bar.
With that said, look at DM II or Parkinson's. VA tends to lump everything together. DM II gets PN and DR (diabetic retinopathy) thrown in on top. Sometimes even renal deficits. I've won L using that argument. Parkinson's gets the same full meal deal treatment with all the extremity deficits combined with facial muscle sag, trouble swallowing, etc. I've won using this argument too.  
What VA does with the SMC S will in large part control what happens some time in the future with an a&a rating. VA will definitely argue the psoriatic arthritis is secondary to the psoriasis under §3.310- which it is. But, for rating purposes under §4.25(b), they are separate and distinct and involve different bodily systems. 
Trust me when I say someone will come along and disagree with me on this subject but my experience is based on actual hands-on litigation for clients-not speculation and conjecture about what VA might or might not do. SMC is very difficult to fathom. My advice is to stress that the two diseases are not one. 
Best of luck, sir.

Well, you have it right for the most part, sir. The only qualifier that you don't "sound out" is that the balance of the ratings that constitute your extra 60% (or more) must all be independently ratable and be separate and distinct from your psoriatic arthritis disability. You'd need to employ §4.25 to add them up. You cannot use anything "left over" from your psoriatic arthritis ratings to fill in the 60% to get to SMC S under §3.350(i)(1). 
Obviously, an alternative, but far more arduous path to get to SMC S would be to get a diagnosis of being "housebound in fact" under §3.350(i)(2).
Best of luck.  

That's where the VA and I digress. VA likes to throw anything and everything associated with a disease into the same basket. The actual language, as parsed in numerous CAVC cases, is the unique language used in §3.350(f)(3) and (4)-
-  must be separate and distinct and involve different anatomical segments or bodily systems.
Based on this, and all the cases I've won citing to this interpretation of the language in the regulation, psoriasis is rated under §4.118. Arthritis is rated under Musculoskeletal (§4.71a) between DC 5002-5010. As such, they are two separate and distinct disease processes/ bodily systems. This is what  I always argue at bar.
With that said, look at DM II or Parkinson's. VA tends to lump everything together. DM II gets PN and DR (diabetic retinopathy) thrown in on top. Sometimes even renal deficits. I've won L using that argument. Parkinson's gets the same full meal deal treatment with all the extremity deficits combined with facial muscle sag, trouble swallowing, etc. I've won using this argument too.  
What VA does with the SMC S will in large part control what happens some time in the future with an a&a rating. VA will definitely argue the psoriatic arthritis is secondary to the psoriasis under §3.310- which it is. But, for rating purposes under §4.25(b), they are separate and distinct and involve different bodily systems. 
Trust me when I say someone will come along and disagree with me on this subject but my experience is based on actual hands-on litigation for clients-not speculation and conjecture about what VA might or might not do. SMC is very difficult to fathom. My advice is to stress that the two diseases are not one. 
Best of luck, sir.

That's where the VA and I digress. VA likes to throw anything and everything associated with a disease into the same basket. The actual language, as parsed in numerous CAVC cases, is the unique language used in §3.350(f)(3) and (4)-
-  must be separate and distinct and involve different anatomical segments or bodily systems.
Based on this, and all the cases I've won citing to this interpretation of the language in the regulation, psoriasis is rated under §4.118. Arthritis is rated under Musculoskeletal (§4.71a) between DC 5002-5010. As such, they are two separate and distinct disease processes/ bodily systems. This is what  I always argue at bar.
With that said, look at DM II or Parkinson's. VA tends to lump everything together. DM II gets PN and DR (diabetic retinopathy) thrown in on top. Sometimes even renal deficits. I've won L using that argument. Parkinson's gets the same full meal deal treatment with all the extremity deficits combined with facial muscle sag, trouble swallowing, etc. I've won using this argument too.  
What VA does with the SMC S will in large part control what happens some time in the future with an a&a rating. VA will definitely argue the psoriatic arthritis is secondary to the psoriasis under §3.310- which it is. But, for rating purposes under §4.25(b), they are separate and distinct and involve different bodily systems. 
Trust me when I say someone will come along and disagree with me on this subject but my experience is based on actual hands-on litigation for clients-not speculation and conjecture about what VA might or might not do. SMC is very difficult to fathom. My advice is to stress that the two diseases are not one. 
Best of luck, sir.

That's where the VA and I digress. VA likes to throw anything and everything associated with a disease into the same basket. The actual language, as parsed in numerous CAVC cases, is the unique language used in §3.350(f)(3) and (4)-
-  must be separate and distinct and involve different anatomical segments or bodily systems.
Based on this, and all the cases I've won citing to this interpretation of the language in the regulation, psoriasis is rated under §4.118. Arthritis is rated under Musculoskeletal (§4.71a) between DC 5002-5010. As such, they are two separate and distinct disease processes/ bodily systems. This is what  I always argue at bar.
With that said, look at DM II or Parkinson's. VA tends to lump everything together. DM II gets PN and DR (diabetic retinopathy) thrown in on top. Sometimes even renal deficits. I've won L using that argument. Parkinson's gets the same full meal deal treatment with all the extremity deficits combined with facial muscle sag, trouble swallowing, etc. I've won using this argument too.  
What VA does with the SMC S will in large part control what happens some time in the future with an a&a rating. VA will definitely argue the psoriatic arthritis is secondary to the psoriasis under §3.310- which it is. But, for rating purposes under §4.25(b), they are separate and distinct and involve different bodily systems. 
Trust me when I say someone will come along and disagree with me on this subject but my experience is based on actual hands-on litigation for clients-not speculation and conjecture about what VA might or might not do. SMC is very difficult to fathom. My advice is to stress that the two diseases are not one. 
Best of luck, sir.

An interesting perspective. Everything there is to know about CUE has already been archived here. All of you just need to look up the accrued wisdom from the CUE meister. Can it be that VA CUE law has been clarified like butter? Maybe. Maybe not. I do hope someone comes along to help you LJL. That is the purpose of the website from what I've been told. Maybe things have changed in this particular subforum. Best of luck.

An interesting perspective. Everything there is to know about CUE has already been archived here. All of you just need to look up the accrued wisdom from the CUE meister. Can it be that VA CUE law has been clarified like butter? Maybe. Maybe not. I do hope someone comes along to help you LJL. That is the purpose of the website from what I've been told. Maybe things have changed in this particular subforum. Best of luck.

Well, you have it right for the most part, sir. The only qualifier that you don't "sound out" is that the balance of the ratings that constitute your extra 60% (or more) must all be independently ratable and be separate and distinct from your psoriatic arthritis disability. You'd need to employ §4.25 to add them up. You cannot use anything "left over" from your psoriatic arthritis ratings to fill in the 60% to get to SMC S under §3.350(i)(1). 
Obviously, an alternative, but far more arduous path to get to SMC S would be to get a diagnosis of being "housebound in fact" under §3.350(i)(2).
Best of luck.  

The enemy of knowledge is not ignorance.
The enemy of knowledge is the illusion of knowledge
Stephen Hawking

When you play VA SMC poker, never leave any money on the table. I know this is chump change but my client might feel different. Win or Die. 
 
redact BVA SMC K win 1.6.22.pdf

Jez, Buck. I didn't know I wasn't supposed to let my clients look at my VBMS feed. I did the TRIPS check ride on VBMS and CASEFLOW back in '18, and they sure didn't forbid this. It's the Vets' information so I cannot fathom why they would not be allowed to see it in real time. Unless, or until someone with authority calls/emails me and tells me not to, I intend to continue. 
As for what VSOs have for a VBMS access level, you got me on that one. Level 6 was enough to get into VistA and CAPRI. Level 7 seems to allow me to view MAPS, CWINRS.exe and TIMS printer default functions I couldn't get into earlier. One thing you have to understand, all we can see is our own clients' files- no others. I'm too busy to go on safari and rattle VBMS' doors. 

I'd add one comment to this chain. I was told I would never be granted access to my own file in VBMS back in '16. Just for S--ts and grins, I put in a VAF 21-22a on myself and bingo-I was in 4 days later. I don't think they dialed in on it. Most of us are granted what's called Level 6 clearance in VBMS. I had a glitch preventing me from seeing a client's file last month and my point of contact here in Seattle  bumped me up to a Level 7 which is as high as an asst. RO director. 
We can see rating decision ready for promulgation. We can see all the ratings decisions, code sheets, c&p exams and the medical opinions. We have access to VHA's VistA computer records on the client. We can see the rater's notes and the rationale for deferrals of claims. We cannot change anything in VBMS but I can change things like a Veteran's current address in VACOLS or upgrade an incorrect POA in CASEFLOW.
Best of all, we are given a VA Outlook email account which comes with an address book of every VA employee from a janitor to a nurse... or a DRO or a rater and his/her title, email address and telephone number. Even Denis the Menace' number and email. 
A tech answering the 800 Dial-a-Prayer number has about a Level 3 and is extremely limited in what they can see. Oddly, my POC here in Seattle says they (VA employees) are not granted access to CASEFLOW. Period. It's like VACOLS and only deals with BVA appeals. I've also been told we can't access VACOLS but I haven't told them I can and do frequently. We can "see" a BVA decision grant or denial roughly 2 weeks before it's published and mailed.
One of these days VA will grant Vets access to this system in a very limited way. The operable phrase is "one of these days".  Here's a partial screenshot of my landing page in VBMS. Each item under Document type is a .pdf we can open to view. There are approximately 3500 Attorneys accredited in this business. Most do more than just VA claims. Oddly, of the 1200-odd NOVA attorneys/agents who only do VA claims and appeals, only about 500 have VBMS access. It's not an arduous process but you have to pass a stupid idiot test for VSOs to get started. Then the fingerprints and the CBI. Then the six month wait as only the VA can make you wait. If I didn't know any better, I'd think they didn't want me nosing around in their computer.
Having VBMS access is a godsend. You can react almost as quickly as they publish it. Since they postdate the letters they send out, some of my §5103 acknowledgements arrive before the date they are mailed to me or the client. That really messes with their minds.  
Happy New Year to all the Hadit crew and all you wonderful Vets. 
 
Spor.asknod22010414490.pdf

A lot of ideas, a lot of conjecture and a lot of suggestions. Let's look at VA's more recent views on SMC.
First, for the higher rates (SMC L and above), the M 21 has tried desperately to conjure up a requirement for a 100% or TDIU rating as the entry ticket to even be considered for the SMC. So, in this case, The Veteran (8th&IMarine) is applying for a&a. A&A doesn't require a 100%/TDIU rating to enter the lottery. Look at §3.151(c)(3):
(c) Aid and attendance; criteria. The veteran, spouse, surviving spouse or parent will be considered in need of regular aid and attendance if he or she:
(1) Is blind or so nearly blind as to have corrected visual acuity of 5/200 or less, in both eyes, or concentric contraction of the visual field to 5 degrees or less; or
(2) Is a patient in a nursing home because of [SC] mental or physical incapacity; or
(3) Establishes a factual need for aid and attendance under the criteria set forth in § 3.352(a).
(Authority: 38 U.S.C. 1502(b))   A Veteran can always go for the extraschedular path to get there, too. But let's look at what we have here. 8&IMarine seeks a SMC L for a&a. He has to prove he cannot accomplish one or more of the activities of everyday living listed in §3.352(a). VA, by operation of law, is going to investigate what particular disability(ies) are responsible for the A&A. S/he is asking VA to determine if s/he is eligible. Akles v. Derwinski and its progeny demand they investigate any and all of his/her SC stuff to determine if they can grant more than just the A&A (or deny). This is open and shut "inferring" a claim for increases that should be rated. Maybe not. A good 2680 ( the eleven page, inward-facing VA DBQ) would be essential here if completed by your private physician. In any case, as BroncoVet points out, it's a §3.103(a) argument-by law they have to maximize your rating. They don't.   What I encounter nowadays is an "everything but the kitchen sink" mentality. VA can (and will) say you need a&a for all those disabilities. So, what happens if you get worse on one of the musculoskeletal issues later-like up to 100% worse? You file for a&a for that one separately and VA says ''sorry charlie-you're using that for the #1 a&a. That would be pyramiding''. I spend an inordinate amount of time trying to de-link these things and get a separate 100% disability rated under SMC L. I always end up at the BVA, too.   Say you went the 100% + 60% and got your SMC S. If you file for a&a and they grant, $100 says they throw all your SMC S stuff into the a&a and deny you any 1/2 step bumps under §3.350(f)(3) or a full step bump under (f)(4) for a 100% rating separate and distinct from the a&a. By law, they can't call something separate and distinct  and independently ratable in 2017 and then come back in 2021 and say it's all one disease/injury process. VA does this to head you off at the pass in the future. They sure don't want you scheming to get R1 if they can cram it all into one a&a rating now. And, it's illegal too.   My advice, for what it might be worth, is to let this ride and see what they develop. You can always NOD and say you never filed for the claims-ergo they are void ab initio. If you file for a&a, try to be specific in your request ("My arthritis makes it impossible to button my shirts or tie my shoelaces." or" My PTSD causes me to forget to take my medications.") If you do not, you'll get the kitchen sink treatment. When, and if, your PTSD does get rated at 100%, you'll want to be filing for a&a for that alone later. You don't want it inextricably intertwined as one of the partial ingredients for the kitchen sink grant of a&a in the present claim. Since the claim is open currently, you could submit a 4138 or the newer 21-10210 version and testify your a&a need is based strictly on your SC  ______________. Get your PCP to write up the 2680 focusing strictly on the disability that provokes the need for a&a.   A lot of Vets do not get this. Filing two A&As is not pyramiding. It's two separate paths to get there (r1) and both are legal. So what if your need for a&a because of your PTSD appears to duplicate your need for a&a due to your Parkinson's? This is the anomaly of SMC. It permits pyramiding primarily because its a quality of life issue, not a ratings percentage of disability. If you have two totally disabling illnesses/injuries, each separately is a qualifier for a&a. Always think big. Do not confine your SMC thinking to the four corners of §3.350(b)(1-4).    Happy Veterans Day. 

No offense, sir, but what you are doing is going to add a lot of time to this project.
VA is an insurance co. They have boxes to check off. It' done with a computer. You're asking them to go analog and off the grid and do your claim "speshull". It doesn't work that way. You come to them hat in hand and ask for whatever it is that floats your boat. They in turn ask you to comply with their protocols. It's a two-way street. Your refusal to comply with their requests will result in the claim being denied because you refuse to play VA ball. VA's duty to assist is a two-way street, and the Veteran cannot wait passively in those situations where his assistance to VA is necessary. See Wood v. Derwinski, 1 Vet. App. 190, 193 (1991).
 
Asking VES to send you paper might work if you're deaf. If you have a phone, they'll use it. You don't get to tell them what you're willing to be examined for at a c&p either. VA tells them.
You're heading for a train wreck but you do not have to believe me. Let's revisit this thread in six months and you report back on how it worked out for you. 

I have to side with BroncoVet on this one. I just filed a Parkinson's Vet for LOU of upper and lower. It was a sketchy chance but it puts a lot of pressure on them to review the whole file. Sure enough, they threw in an increase c&p for his MDD anxiety due to the Parkinson's that I did not ask for. The exam was Friday morning. He was at 30%. The shrink said he was totally bugf--ky and gave him 100%. He went to the c&p at 1000 hrs. By 1330 Hrs, the DBQ was posted in VBMS. You can see what's coming. They're trying to head off the R 1 by munificently granting the a&a for bent brain instead of granting two LOUs and R 1. 
Of course, in this case, I'll just use it to get R 1 anyway. His current TDIU has been in effect for over 5 years. If anything, the a&a should be granted for the sum of the Parkinson's ratings alone -not the bent brain. So, the takeaway discussion that you shouldn't entertain VA shopping an increase solely because you fear a reduction is a product of too many VSOs telling you not to be greedy. 
This is VA poker. Never be afraid to seek what you are due. After 30 years of this, I think I've seen everything. VA is not your friend but never take a glass-half-empty approach. Go big or go home. If they reduce, 9 times out of ten they do it illegally and you just win with §3.344 and say it's a single c&p. To reduce, they need two c&ps  in order to prove you can sustain the improvement forever. I do not know of many disease/injury processes that improve with time-if any. 
Best of luck. 

I foresee VA will let the claim continue as is. They'll send you a c&p date. When you go, they'll ignore your contention about not wanting to file for increase. They will probably increase something small upwards about 10 % and call it good. Maybe they'll grant a&A. Maybe not. Can't see your Code sheet. 
One thing I've learned in this is they do not pay any attention to what you want. In this case, you're asking to enter the higher SMCs. That entails an in-depth examination of all your disabilities and the inferred responsibility to try to grant you the highest and best rating they can. The problem is they tend to try to find something to reduce you if you are not p&t.
Seems a lot of Vets think VA is on a constant mission to reduce you. VA gets this idea from records produced at VAMCs. So if you use the VA for your medical, you leave yourself wide open to getting whacked. Once you are p&t, you can apply for SSA/SSD and get your medical outside VA. Then they cannot see your purported "improvement". VA doctors always report wrongly most times or fail to convey the level of a disability. I have a gal with MS who came in to Hampton VAMC for her monthly infusion for multiple sclerosis. The nurse writes "pt. is ambulatory". Yep. She sure was. Her husband was holding her left arm and her right leg was riding on a knee scooter. Somehow that didn't get into the record. Only the VA would record something like that-never a civvie nurse. Did you know if you go to their lab for blood work and they do a urine on you that the urinalysis includes a drug test? 
Shoot. Some things get better. Granted, most do not. If you live in a sub-TDIU rating world or are not p&t yet, you are always a sitting duck. Don't give them the ammo to reduce you by saying stupid things at c&ps. No smiling. No Happy chat. Never diagnose yourself or they'll use it against you. 
At a Vet's c&p for status post encephalitis symtoms, his spouse said he had "anger management issues." The c&p guy immediately accepted her nonexistent psychology degree and used her testimony to say the guy's anger wasn't due to TBI symptoms . Boom TBI gets reduced to 0%. 
Learn VA's tricks before they use them against you.
Happy Thanksgiving.

A lot of ideas, a lot of conjecture and a lot of suggestions. Let's look at VA's more recent views on SMC.
First, for the higher rates (SMC L and above), the M 21 has tried desperately to conjure up a requirement for a 100% or TDIU rating as the entry ticket to even be considered for the SMC. So, in this case, The Veteran (8th&IMarine) is applying for a&a. A&A doesn't require a 100%/TDIU rating to enter the lottery. Look at §3.151(c)(3):
(c) Aid and attendance; criteria. The veteran, spouse, surviving spouse or parent will be considered in need of regular aid and attendance if he or she:
(1) Is blind or so nearly blind as to have corrected visual acuity of 5/200 or less, in both eyes, or concentric contraction of the visual field to 5 degrees or less; or
(2) Is a patient in a nursing home because of [SC] mental or physical incapacity; or
(3) Establishes a factual need for aid and attendance under the criteria set forth in § 3.352(a).
(Authority: 38 U.S.C. 1502(b))   A Veteran can always go for the extraschedular path to get there, too. But let's look at what we have here. 8&IMarine seeks a SMC L for a&a. He has to prove he cannot accomplish one or more of the activities of everyday living listed in §3.352(a). VA, by operation of law, is going to investigate what particular disability(ies) are responsible for the A&A. S/he is asking VA to determine if s/he is eligible. Akles v. Derwinski and its progeny demand they investigate any and all of his/her SC stuff to determine if they can grant more than just the A&A (or deny). This is open and shut "inferring" a claim for increases that should be rated. Maybe not. A good 2680 ( the eleven page, inward-facing VA DBQ) would be essential here if completed by your private physician. In any case, as BroncoVet points out, it's a §3.103(a) argument-by law they have to maximize your rating. They don't.   What I encounter nowadays is an "everything but the kitchen sink" mentality. VA can (and will) say you need a&a for all those disabilities. So, what happens if you get worse on one of the musculoskeletal issues later-like up to 100% worse? You file for a&a for that one separately and VA says ''sorry charlie-you're using that for the #1 a&a. That would be pyramiding''. I spend an inordinate amount of time trying to de-link these things and get a separate 100% disability rated under SMC L. I always end up at the BVA, too.   Say you went the 100% + 60% and got your SMC S. If you file for a&a and they grant, $100 says they throw all your SMC S stuff into the a&a and deny you any 1/2 step bumps under §3.350(f)(3) or a full step bump under (f)(4) for a 100% rating separate and distinct from the a&a. By law, they can't call something separate and distinct  and independently ratable in 2017 and then come back in 2021 and say it's all one disease/injury process. VA does this to head you off at the pass in the future. They sure don't want you scheming to get R1 if they can cram it all into one a&a rating now. And, it's illegal too.   My advice, for what it might be worth, is to let this ride and see what they develop. You can always NOD and say you never filed for the claims-ergo they are void ab initio. If you file for a&a, try to be specific in your request ("My arthritis makes it impossible to button my shirts or tie my shoelaces." or" My PTSD causes me to forget to take my medications.") If you do not, you'll get the kitchen sink treatment. When, and if, your PTSD does get rated at 100%, you'll want to be filing for a&a for that alone later. You don't want it inextricably intertwined as one of the partial ingredients for the kitchen sink grant of a&a in the present claim. Since the claim is open currently, you could submit a 4138 or the newer 21-10210 version and testify your a&a need is based strictly on your SC  ______________. Get your PCP to write up the 2680 focusing strictly on the disability that provokes the need for a&a.   A lot of Vets do not get this. Filing two A&As is not pyramiding. It's two separate paths to get there (r1) and both are legal. So what if your need for a&a because of your PTSD appears to duplicate your need for a&a due to your Parkinson's? This is the anomaly of SMC. It permits pyramiding primarily because its a quality of life issue, not a ratings percentage of disability. If you have two totally disabling illnesses/injuries, each separately is a qualifier for a&a. Always think big. Do not confine your SMC thinking to the four corners of §3.350(b)(1-4).    Happy Veterans Day.